What Happens When a Healthcare Startup Leaves You With the Bill • Hacker News Board

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#71

Post by digikata » Thu, Jul 03, 2014, 7:41 PM UTC

eggbrain wrote: post #12

I had a conversation with a friend recently who was a doctor. He was telling me that he had 3 patients in a fairly short period of time that had come in with mysterious symptoms (they were all in their 70's) and that had died soon after being admitted. While he knew that he had technically done everything by the book to treat them, he worried that he had made a mistake along the way that possibly could have been the…

I recall hearing a discussion on the radio from a medical administrator re: the rate autopsies. IIRC the rate of autopsies has dropped dramatically in past few decades. There are many short-term administrative, financial & legal reasons to skip an autopsy, but it seems like a bad trend. While it's not ethical to A/B test human medical treatment in regular care, autopsies would seems like a critical data source to make improvements in health care - seems like yet another variant of "tragedy of the commons" problem that the rates are systematically declining.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#72

Post by bbarn » Thu, Jul 03, 2014, 7:43 PM UTC

xienze wrote: post #41

bbarn wrote: post #5

I find the phrase "Don't A/B test with people's lives" to be in search of something catchy, or a zinger. The reality of big insurance has always been to be paid more than they pay out. Simple. You've always been a number to an insurance company.

> The reality of big insurance has always been to be paid more than they pay out. Well yes, that's how a company stays solvent... The problem with health insurance is that it's been perverted into a discount club rather than being insurance for catastrophic occurrences. It divorces consumers from the true cost of services and hence service providers are free to play with the costs all they want. Hell, you can't even…

I've always viewed it as an arms race to see who can get away with what between providers, insurers, and patients (and before ACA, employers to a degree).

The true cost of service at this point includes having staff and systems (with their own support staff) to negotiate and calculate the cost on both the insurer and the provider side.

So, in a way, if you have one particularly tough to deal with insurer, that cost gets distributed among all patients, and their insurers as well. In addition, the basic cost of any visit now includes some of that administrative overhead.

In the oil change analogy, if you had to walk into the shop, and there was a base price of $50 to cover the administrative costs, you had to wait until you saw a mechanic to decide if you really needed an oil change, and they charged $50, and then you paid the $20 dollars for the oil change, you can bet by now someone would have started marketing a per-visit copay style insurance for cars too.

None of this is to say I disagree with you, just that it's even worse than I think we all think it is.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#73

Post by grandinj » Thu, Jul 03, 2014, 7:45 PM UTC

pessimizer wrote: post #69

chimeracoder wrote: post #66

Earlier quoted context omitted.

> If our health sector ran as efficiently as everyone else's (as a fraction of GDP/capita), the money we currently pay for medicare and medicaid would suffice to provide universal coverage for every single person in the US. This isn't an apples-to-apples comparison for several reasons (some which overstate the amount of money, some which understate). One, there are a number of things which fall under Medicare's budge…

>This isn't an apples-to-apples comparison. It really is, and has nothing to do with the current state of Medicare and what it covers. Our per-capita government health care expenditures are far higher than systems that both have better outcomes and that also don't charge at the point of delivery. Our doctors make twice as much as everyone else's doctors, and that is only sustained because they are both protected from…

Your drugs are expensive because the rest of the world freeloads by artificially restricting the selling price of drugs, leaving the US to bear the brunt of the R&D costs.

Your FDA and legal system pushes up the price of medical devices.

But yes, you have the most unnecessarily complex and convoluted health care administrative structure known to man.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#74

Post by chaostheory » Thu, Jul 03, 2014, 7:45 PM UTC

lsc wrote: post #55

jackgavigan wrote: post #32

There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents. Sometimes that works out but I believe that a new entrants chances of success are a lot higher if they have somebody on board who is actually familiar with the industry sect…

I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values. I mean, consider for a moment how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. Multiply that by the…

Kaiser is great. The problem is with Kaiser is that it's not available nationwide. If I remember, it's only available in big metros.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#75

Post by debacle » Thu, Jul 03, 2014, 7:46 PM UTC

lsc wrote: post #55

jackgavigan wrote: post #32

There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents. Sometimes that works out but I believe that a new entrants chances of success are a lot higher if they have somebody on board who is actually familiar with the industry sect…

I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values. I mean, consider for a moment how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. Multiply that by the…

> how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled.

I have had nothing but excellent experiences with both my car insurance company and my homeowners insurance company.

The trick to having a good relationship with your insurance company is to have a good insurance company.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#76

Post by nickff » Thu, Jul 03, 2014, 7:46 PM UTC

pessimizer wrote: post #69

chimeracoder wrote: post #66

Earlier quoted context omitted.

> If our health sector ran as efficiently as everyone else's (as a fraction of GDP/capita), the money we currently pay for medicare and medicaid would suffice to provide universal coverage for every single person in the US. This isn't an apples-to-apples comparison for several reasons (some which overstate the amount of money, some which understate). One, there are a number of things which fall under Medicare's budge…

>This isn't an apples-to-apples comparison. It really is, and has nothing to do with the current state of Medicare and what it covers. Our per-capita government health care expenditures are far higher than systems that both have better outcomes and that also don't charge at the point of delivery. Our doctors make twice as much as everyone else's doctors, and that is only sustained because they are both protected from…

The statistics on medically-related bankruptcy are usually flawed, and overstate the extent of this problem. They usually assume that if you owed more than $(small amount) in healthcare debt, (exact amount varies by study,) the bankruptcy was caused by this debt. Some of the better studies use healthcare debt as % of total debt accumulated in year(s) before bankruptcy, and come out with much lower figures.[1]

It makes sense that if you owe a lot of money, some of it would be to a sector which makes up a large part of the economy, and an even larger part of consumer spending. To put it another way, if you measured the impact of car debt the same way that most studies measure the impact of healthcare debt, you would see that cars cause many, if not most bankruptcies (which is an absurd result, as most people can easily liquidate a car and move to a lower cost option).

[1] will get a citation when I have a little more time

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#77

Post by bbarn » Thu, Jul 03, 2014, 7:51 PM UTC

chimeracoder wrote: post #66

jjoonathan wrote: post #42

Earlier quoted context omitted.

It's evil, inconvenient, and (amazingly) it's even less efficient that its government-run counterparts both inside and outside the US: http://healthcarereform.procon.org/view.resource.php?resourc... What will it take to convince people of this? Our society already accepts that markets aren't a suitable medium for every human endeavor, how long must we continue to experiment with private (basic) health insurance befor…

> If our health sector ran as efficiently as everyone else's (as a fraction of GDP/capita), the money we currently pay for medicare and medicaid would suffice to provide universal coverage for every single person in the US. This isn't an apples-to-apples comparison for several reasons (some which overstate the amount of money, some which understate). One, there are a number of things which fall under Medicare's budge…

>It's easy to say that "costs are too high" - that's fine, but where are they too high?

I have two (totally anecdotal) answers, from my own experiences and those of my former partner, who spent 15 years working in hospitals:

1 - Administrative overhead. Especially with billing and insurance. 2 - Practices, procedures, and policies to prevent lawsuits. Needless waste, lack of reuse of items that could be cleaned, and safely reused, high premiums for malpractice insurance, training efforts and refusal to make decisions out of fear of suits.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#78

Post by swalkergibson » Thu, Jul 03, 2014, 7:53 PM UTC

xienze wrote: post #41

bbarn wrote: post #5

I find the phrase "Don't A/B test with people's lives" to be in search of something catchy, or a zinger. The reality of big insurance has always been to be paid more than they pay out. Simple. You've always been a number to an insurance company.

> The reality of big insurance has always been to be paid more than they pay out. Well yes, that's how a company stays solvent... The problem with health insurance is that it's been perverted into a discount club rather than being insurance for catastrophic occurrences. It divorces consumers from the true cost of services and hence service providers are free to play with the costs all they want. Hell, you can't even…

Comparing cars to human beings is disingenuous. A car is a machine with a finite number of parts and well-documented methods of action.

A human body is an enormously complicated set of systems that can mysteriously fail at anytime for no reason at all, and then fix itself without intervention at times. There is a reason doctors are "in practice."

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#79

Post by lotharbot » Thu, Jul 03, 2014, 8:10 PM UTC

dragonwriter wrote: post #67

maxsilver wrote: post #54

Earlier quoted context omitted.

It gets even worse than that. Some people are stuck with an HSA. A HSA is not insurance (it covers nothing), but it looks like insurance (so hospitals still charge you the 'ten times more' price). A $100 doctor visit, becomes $900 "charged" to your HSA (because you 'have insurance' so they can eat the artificially-inflated cost). But since HSA never covers anything, the insurance always just passes that $900 bill on…

HSAs are, by legal requirement, only available if you are enrolled in a High-Deductible Health Plan [1], which is insurance and does pay for something , though (as the name suggests) it has a very high annual deductible (for which the HSA is used). So if you have an HSA, you do, in fact, have insurance. [1] http://en.wikipedia.org/wiki/Health_savings_account

or you might have an HSA left over from when you used to have insurance. (FSAs expire at the end of the year, but HSAs are permanent.)

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#80

Post by DatBear » Thu, Jul 03, 2014, 8:31 PM UTC

>In the emerging health and wellness markets, startups like Oscar intimately disrupt and destroy their customer's lives through incorrect datasets where an A/B testing mentality results in exorbitant fees, angry hospital administrators and patients with no recourse except to bankrupt themselves paying bills they didn't expect.

This doesn't make sense to me. How is an A/B testing mentality at fault for this? It has nothing to do with the incorrect datasets... you don't A/B test your data structure... I hope. A/B tests are blamed later in the article too, not really sure why.